Substance use among older adults attending outpatient clinics at the Moi Teaching and Referral Hospital Eldoret, Kenya

Abstract

Background: National Authority for the Campaign against Alcohol and Drug Abuse (NACADA) in 2022 reported that over the past ten years, substance use has considerably increased throughout Kenya. However, there is limited literature regarding substance use among specific populations particularly older adults (50 years and above) as the national estimates do not disaggregate substance use by older age groups. Objectives: The objectives of this study were: to determine the prevalence of substance use, to assess factors associated with substance use, and to establish the preferred interventions to substance use among older adults attending the Outpatient Clinics at the Moi Teaching and Referral Hospital (MTRH). Methods: The study adopted a cross-sectional design that employed a quantitative approach. Stratified sampling was used to select five Outpatient Clinics at MTRH. Within the Clinics, consecutive sampling was used to select 402 consenting older adults. A questionnaire and the WHO Alcohol, Smoking and Substance Involvement Test (ASSIST) tools were used to collect data. The University of California Brief Assessment of Capacity to consent (UBACC) was used to assess participants’ capacity to consent. Data was analyzed using descriptive analyses including: mean, frequencies and percentages to summarize data and analyze the prevalence. Chi- square and logistic regression were used to measure associations. Results: The life prevalence of substance use among older Adults attending Outpatient Clinics at MTRH was 80% and the prevalence based on the past three months was 66.7% (95% CI; 1.53%-1. 63%). The Commonly used substances in order of prevalence were; alcohol (42%), tobacco (16.8%), cannabis (6.7%) and inhalants (1.2%). Factors associated with substance use were; Age 55-59 years (36.8%, p=0.001), married people (37.0%, p=0.001), religion (Christians) (40.5%, p=0.001), income of below 9,999 Kenyan shillings (21.5%, p=0.001), those not working (31.4%, p=0.001), those with chronic illness (43.7%, p=0.001) and those with a history of substance use (54.8%, p=0.000). From logistic regression model family history of substance use and chronic illness were significantly associated with substance use. Professional counselling taking a longer time; above six weeks (p=.002), Peer Support Group (p=.003) and pharmacological treatment (p=.001) were the preferred inteventions for substance use. Conclusion: There was a high prevalence of substance use among older adults attending Outpatient Clinics at MTRH. The most commonly used substance was alcohol. Factors associated with substance use were: being married, low monthly income, family history of substance use, and having a chronic illness. Most preferred interventions were: professional counseling, peer support group and pharmacological treatment. Recommendations: The study recommends individualized interventions to address substance use among older adults. MTRH need to screen for substance use and focus counseling services on adults attending the clinics; and NACADA needs to enhance programs specific to older adults to facilitate prevention and minimize substance use.